- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $7,079.46 / $9,772.37
| Facility | | $2,398.83 | $7,079.46 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,137.96 / $5,623.41
| Professional | | $1,905.46 | $2,137.96 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $21,877.62 / $34,673.69
| Facility | | $10,000.00 | $21,877.62 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $4,168.69 / $5,888.44
| Professional | | $2,041.74 | $4,168.69 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $3,890.45 / $6,165.95
| Professional | | $870.96 | $3,890.45 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,715.35 / $6,165.95
| Professional | | $2,290.87 | $3,715.35 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,630.78 / $6,165.95
| Professional | | $2,344.23 | $3,630.78 | $6,165.95 |